Download REM Behavior Disorder

Volume I, Issue 6
REM Behavior Disorder
Overview
Patients with rapid eye movement behavior
disorder (RBD) act out dramatic and/or
violent dreams during rapid eye movement
(REM) stage sleep. Another feature of
RBD is shouting and grunting. RBD seems
similar to other sleep disorders that involve
motor activity, like sleepwalking or
periodic limb movement disorder. Unlike
these conditions, RBD movements occur
during REM sleep, which is usually
characterized by a state of atonia, or sleep
paralysis. Diagnosis and treatment involves
Polysomnography with video, drug
therapy, and the exclusion of potentially
serious neurological disorders. It also may
be necessary to record several nights of
ambulatory Electroencephalograph (EEG).
The patient may be awakened or may wake
spontaneously during the attack and have
vivid recall of the dream that corresponds
with the physical action.
Quick Facts about REM Behavior Disorder
Presentation
RBD episodes are often triggered by physical dreams that involve fighting,
kicking, dancing etc. Some people have been known to run out of bed, down
stairs, into walls or out doors and windows. However, most RBD activity is
confined to the bed.
Diagnosis
RBD is usually diagnosed by a thorough patient history, videos of REM sleep
activity and polysomnography. In severe cases of RBD that do not respond to
treatment, MRI scans can be helpful in detecting other conditions that may
cause similar episodes.
Treatment
Often people with RBD risk injury to themselves or their bed partners. Separate
beds in ground floor bedrooms are recommended. Homes should have latches
and locks on all doors. Windows should have heavy curtains to make walking
through them more difficult. Sharp objects and furniture should be removed
form the sleeping areas. Often the RBD sufferer doesn’t understand these
precautions because he has no memory of the episodes.
RBD is usually seen in men 60 years old
or older, but also occurs in younger people
and in women. Incidents of REM behavior
disorder are often described anecdotally to
family members and not to physicians, so
statistics of incidence are inexact. In the
general population, the estimated
occurrence of RBD is .5%. There are no
racial differences in incidence and
prevalence.
No death has been reported, however
patients and bed partners may experience
serious injury.
Cynthia C. Bamford, MD
Vernon H. Kirk, MD
Robert A. Lada, MD
José C. Rafecas, MD
Frankie Roman, MD
Lawrence M. Saltis, MD
REM Behavior Disorder
continued from front
Physiology and Causes
Rapid eye movement behavior disorder is
an uncommon sleep disorder first described
in 1986. There is no known cause for RBD.
It is, however, known to occur during rapid
eye movement sleep, which is
characterized by brain activity patterns that
resemble wakefulness and which has been
documented with polysomnography and
other sleep tests. Most dreaming occurs
during REM sleep. Another characteristic
of REM sleep is a general state of atonia,
or muscle paralysis. So, while the brain is
very active during REM sleep, the body is
usually still.
Sleep Paralysis
The basic mechanism for REM sleep
paralysis is found in the brainstem, the part
of the brain that connects the spinal cord
to the cerebral hemispheres. Though
physicians do not thoroughly understand
the complex processes, it is known that the
brainstem undergoes changes in REM
sleep that result in paralysis of the body’s
voluntary
muscles.
Certain
neurotransmitters, like acetylcholine
(Ach), become dormant and do not
communicate motor activity. The absence
of muscular contraction during REM can
be seen with Polysomnography. The
electroencephalogram (EEG) shows
elevated brain activity during REM.
Physicians hypothesize that the brain
naturally and purposely prevents motor
activity during REM sleep to ensure restful,
inactive sleep during the most electrically
active stage of sleep. In this context, sleep
paralysis describes a normal state of sleep,
unlike sleep paralysis experienced in
Narcolepsy, which affects people while
they are trying to stay awake.
Motor Activity and REM Sleep
In RBD, neurotransmitters are not blocked,
and the voluntary muscles become tonic,
or tensely contracted, allowing a sleeping
person to move his or her muscles during
REM. Rapid eye movement behavior
disorder is characterized by significant
submental (under the chin) and limb
muscle tone. The combination of
heightened cerebral activity and muscular
tonicity results in physically acting out
dreams that involve excited and sometimes
violent movement.
The body can be rigid and extremely tense
during episodes of RBD. For example, a
person might straighten his or her leg,
flexing it intensely for several seconds or
a minute. Often, sleepers curl up slightly,
while flexing their limbs and chin.
NNA is proud to announce the opening of our
new 4 bed, full service sleep center at 3985
Medina Road, Suite 200 in Medina! At this
location we offer day and night sleep studies
and comprehensive diagnosis and treatment of
sleep related problems. Dr. Vernon Kirk, a
board certified sleep physician oversees the
new Ohio Sleep Disorders Center in Medina.
People with RBD typically remember little
nothing of this activity, unless they fall out
of bed, bump into the furniture, or injure
themselves and wake up. But they can
usually remember and tell the dreams they
were having during an episode.
Dreams that involve physical or violent
activity—such as fighting, dancing,
running, chasing, attacking, being attacked,
running from an assailant—are more likely
to trigger RBD activity. Sleepers with RBD
sometimes injure their bed partners. Some
people have been known to leave the bed,
run into a wall, run through a window, or
run down the stairs. Usually, RBD activity
is confined to the bed and surrounding
areas.
Treatment
REM Behavior disorder is treated
symptomatically by various medications
although the response may vary in
individual cases. Therefore, all medications
should be tried before considering the
patient’s RBD intractable. Also,
environmental precautions should be taken
such as removing sharp objects from the
bedroom.
Congratulations to our own Dr. Robert Lada
for completing one year of training in sleep
medicine and for passing the oral and written
board exams presented by The American
Academy of Sleep Medicine. His certification
makes him a part of NNA’s prestigious team
of board certified sleep physicians : Cynthia
Bamford, Vernon Kirk, José Rafecas,
Frankie Roman and Lawrence Saltis.
Trust the Sleep Experts at Ohio Sleep.